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- MONITORING WELL INSTALLATION REPORT <br /> 7"h141asf <br /> l . <br /> Date:_ CONSTRUCTION <br /> Premise Address:_ (b le,V% n /�wl�e�'��, Total Depth_ <br /> Screen Length (from)_ 2,r1 (to)_ 3 9 <br /> Well No.: IZ W1.t,J - Filter Pack (from) .Lh• S (to)—.4 If <br /> — <br /> Inspector: _ I �nw•ccn Bentonite (from)_ 2 (CO) —GGrout �--�- <br /> (from) (to)—J-_ <br /> Drilling rig type <br /> Permit No. -2 `-Z Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company:_ Te,r4/Ayv`,rnt r C , <br /> Driller: W�e�{SQ _ casing <br /> F[mjiT <br /> he_ght <br /> Consultant_ C���...e,Z► s .� <br /> Geologist_ /►G <br /> • T� A A YE-G r"l-CUN D <br /> CO x'LG DON C�_nZiY_ oX <br /> SPECIAL PERMIT INFO. G=nj xCO+'�Ptc-T1CN Ststs <br /> Distance to sewer line <br /> Domestic well on site .- (y/ n) <br /> If yes, location and distance <br /> a1g,S— <br /> SA.MPLING - s <br /> s oc-icn -� <br /> Holding Temperature <br /> Method" <br /> Screening Method =' <br /> Tracking Sheet (y/ n ) <br /> "j3R n, w — '—ft. <br /> SPOILS <br /> Storage Method ty MATERIALS/DEVELOPMENT <br /> Cont4mination Noted - (y <br /> Storage Locadon Casing type Z PV <br /> Blank ;L ct ft. Screen X ft. <br /> Slot size .0%0 <br /> GROUTING Bags cement C�H <br /> Buckets bcntonit I <br /> Depth to water N 'L 6 Bags sand/gravel N 1 vOC9 <br /> Mix Rados_ N 2c-i l 1-6 Q !I Lf Filter Pack type/size -s- 12 <br /> �stalladon Method `_ �� Surge Block;- a/ 11 ) <br /> QuantityInstalledDiscussed Vnth geologist: - ©/ n <br /> Type of method <br /> EH 29 29. . <br />